Active NPI
Larry Martin Wiertz, M.D.
- Endocrinology, Diabetes & Metabolism Physician
- Tyler, TX
National Provider Identifier
1104928019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician
- License
- F0822
- Practice address
- 7516 Hollytree Dr
Tyler, TX 75703-0928 - Phone
- (903) 561-1192
- NPI assigned
- Sep 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | F0822 | TX | Primary |
Addresses
Primary practice location
7516 Hollytree Dr
Tyler, TX 75703-0928
Mailing address
7516 Hollytree Dr
Tyler, TX 75703-0928
Phone (903) 561-1192
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RAILROAD MEDICARE | Other | TX | 827113008 |
| P00404433 | Other | TX | RAILOAD MEDICARE |
| 128562906 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263340800000",
"number": "1104928019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7516 HOLLYTREE DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757030928",
"telephone_number": "903-561-1192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7516 HOLLYTREE DR",
"city": "TYLER",
"state": "TX",
"postal_code": "757030928",
"telephone_number": "903-561-1192"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIERTZ",
"first_name": "LARRY",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-01",
"last_updated": "2010-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "207RE0101X",
"taxonomy_group": "",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "TX",
"license": "F0822",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "827113008",
"identifier": "RAILROAD MEDICARE",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILOAD MEDICARE",
"identifier": "P00404433",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "128562906",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.